Pancreatic function testing is best determined by the extended endoscopic collection technique.
OBJECTIVE
To evaluate whether the extended secretin-stimulated direct endoscopic pancreatic function test (ePFT) technique is superior to the rapid 15 minute secretin-stimulated ePFT in determining pancreatic exocrine function.


METHODS
We conducted a retrospective study of 53 patients with chronic abdominal pain and normal pancreatic imaging. These patients had ePFT testing with the following modified endoscopic collection system. Porcine synthetic or human secretin was intravenously administered 15 minutes before endoscopic duodenal aspiration. The first 10-minute collection was performed in the third portion of the duodenum. A Liguory drainage tube was placed in the third portion of the duodenum. Two additional 10-minute-period collections were obtained via the drainage tube at 30 and 45 minutes after intravenous administration of secretin. All fluid collections were analyzed for bicarbonate (HCO3) concentration.


RESULTS
Peak HCO3 concentrations at 15 minutes occurred in 62%, at 30 to 40 minutes in 23%, and at 45 to 55 minutes in 15%. Normal concentrations of HCO3 (> or =80 mEq/L) were seen in 70%, abnormal concentration in 7%, and equivocal concentrations (60-79 mEq/L) in 23% even after 55 minutes of duodenal collections.


CONCLUSIONS
Collections beyond 15 minutes are necessary to improve accuracy of the ePFT in determining pancreatic exocrine function.
Moolsintong
Picha
P
Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Louis University, St Louis, MO 63110, USA. Moolsintong@yahoo.com
Burton
Frank R
FR
D015746:Abdominal Pain / Q000209:etiology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001639:Bicarbonates / Q000378:metabolism; D003951:Diagnostic Errors / Q000517:prevention & control; D004384:Duodenoscopy; D004386:Duodenum / Q000378:metabolism; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007419:Intestinal Secretions / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D046790:Pancreas, Exocrine / Q000503:physiopathology*; D010182:Pancreatic Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D010186:Pancreatic Function Tests / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012633:Secretin / Q000008:administration & dosage; D013997:Time Factors; D055815:Young Adult
D001639:Bicarbonates; D012633:Secretin